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A brief history of croup is presented. The forms of croup under examination are defined with emotional factors at one end of a continuum and viral and traumatic factors at the other. The complexity of the disorder and its peculiar clinical characteristics are explained. Some of these characteristics are: (1) the predominant 1-3-year age range, which corresponds to the anal stage of development; (2) the relief afforded by vomiting; (3) the occurrence of attacks at night and during sleep, (4) the relative dryness of the cough and its harsh metallic quality; (5) the frequent presence of a ticklish, irritating sensation in the throat; and (6) the presence of edema and/or laryngospasm. Three case vignettes are presented. These cases support a previously developed theory concerning the impulses and defenses underlying the croup attack. Croup is seen as a fixation at the oral level with a regression to that level in the face of
Supervising analyst in the Child and Adolescent Division of the Institute of the Philadelphia Association for Psychoanalysis and a member of the faculty. He is associate professor of Pediatrics and Child Psychiatry, Allegheny University Health Systems, Hahnemann Division, and senior attending physician, Belmont Center for Comprehensive Care in Philadelphia.
Dr. Jan Doeff assisted with the translations. I am grateful for the support I received from both the late Dr. Mitchell Dratman and the late Dr. Elizabeth Bremner Kaplan.
The Psychoanalytic Study of the Child 53, ed. Albert J. Solnit, Peter B. Neubauer, Samuel Abrams, and A. Scott Dowling (Yale University Press, copyright © 1998 by Albert J. Solnit, Peter B. Neubauer, Samuel Abrams, and A. Scott Dowling).
conflicts of the anal or sometimes the oedipal stage. The psychosexual development of the larynx is discussed.